Provider Demographics
NPI:1487921607
Name:SCOTT R. VAN WILPE, D.C., P.A.
Entity type:Organization
Organization Name:SCOTT R. VAN WILPE, D.C., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:VAN WILPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-636-5322
Mailing Address - Street 1:2870 W WALNUT ST STE 3
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-0321
Mailing Address - Country:US
Mailing Address - Phone:479-636-5322
Mailing Address - Fax:479-636-5393
Practice Address - Street 1:2870 W WALNUT ST STE 3
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-0321
Practice Address - Country:US
Practice Address - Phone:479-636-5322
Practice Address - Fax:479-636-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR#1166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty